Infant Hip

US examination of the hip has mostly been dedicated to examination of the infant hip to detect developmental hip dysplasia. More recently, the development and refinement of small-parts transducers and the widespread consciousness of the capabilities of US in the assessment of musculoskeletal disorders have increased the number of US examinations of the hip in adults. This chapter deals with the normal anatomy, technique of examination and pathologic findings of the hip joint and hip region. 

Dynamic US examination of the infant hip was first described by Harcke (Harcke etal. 1984). Compared with Grafs technique, Harcke s approach, which is widely used in the United States, emphasizes instability as the main abnormality for monitoring rather... 

Unlike transient synovitis, septic arthritis of the infant hip tends to occur in a younger age group (<3 years old). In neonates, it is more often associated with concomitant femoral osteomyelitis. As already described in Chapter 5, Staphylococcus aureus and Gram-negative anaerobes are the most... 

Abiri MM, Kirpekar M, Ablow RC (1989) Osteomyelitis detection with ultrasound. Radiology 172 509-511 Ablin DS, Jain K, Howell L et al (1998) Ultrasound and MR imaging of fibromatosis colli (sternomastoid tumor of infancy). Pediatr Radiol 28 230-233 Amodio J, Rivera R, Pinkney L et al (2006) The relationship between alpha angle and resistive index of the femoral epiphysis in the normal and abnormal infant hip. Pediatr Radiol 36 841-844... 

Harcke HT, Grissom LE (1994) Infant hip sonography current concepts. Semin Ultrasound CT MR 15 256-263 Harcke HT, Grissom LE (1999) Pediatric hip sonography. Diagnosis and differential diagnosis. Radiol Clin North Am 37 787-796... 

Harcke HT, Kumar SJ (1991) The role of ultrasound in the diagnosis and management of congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 73 622-628 Harcke HT, Clarke NM, Lee MS et al (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3 131-137... 

Morin C, Harcke HT, MacEwen GD (1985) The infant hip realtime US assessment of acetabular development. Radiology 157 673-677... 

Radiol Clin North Am 26 29-53 Novick G, Ghehnan B, Schneider M (1983) Sonography of the neonatal and infant hip.AJR Am J Roentgenol 141 639-645 Pratt WB, Freiberger RH, Arnold WD (1982) Untreated congenital hip dysplasia in the Navajo. Clin Orthop 162 69-77 Riebel TW, Nasir R, Nazarenko O (1996) The value of sonog-... 

The sites for IM administration are the deltoid muscle (upper arm), the ventrogluteal or dorso-gluteal sites (hip), and the vastus lateralis (thigh Pig. 2-7). The vastus lateralis site is frequently used for infants and small children because it is more developed than the gluteal or deltoid sites, hi children who have been ambulating for more than 2 years the ventrogluteal site may be used. 

Bob puts his hands on his hips. Why don t you ask God to solve this problem We asked, but there is no reply. We don t want a heat death to happen. We must learn more. In order to increase our intelligence, we will swap the brain hemispheres of infants of different species. They ll all be hybrids with new ways of looking at the Universe. Our preliminary research indicates that they will think new thoughts and contemplate the fabric of reality in ways we can never fathom. We have the technology to fuse the brains, but not the intelligence to think their thoughts. ... 

Epileptics have low blood Mn A link between mseleni disease and Mn deficiency Low tissue Mn in MSUD and PKU Mn deficiency and hip dislocation in Down s syndrome Low hair Mn in infants with congenital malformations and their mothers Low blood Mn in non-head injury epileptics Low blood Mn in osteoporosis Experimental Mn deficiency in male subjects ... 

In adults receiving long-term parenteral nutrition, despite its anabolic effects on other tissues, there is no improvement in bone density. Infants treated with parenteral nutrition from birth also develop low bone density for age, suggesting that parenteral nutrition treatment in some way contributes to the osteopenia (5). A 17% long-term increase in spinal bone mineral content has been shown in patients who have received parenteral nutrition solntions without vitamin D. However, this rise was nearly balanced by a 15% fall in hip bone mineral content (115). In a Danish study of bone mineral content in adults receiving home parenteral nutrition for short bowel syndrome, despite the fact that all were on free oral intake as a supplement to the parenteral nutrition, 47% had mandibular osteoporosis while 33% had osteoporosis in the forearm and radiographic changes of osteoporotic fractures in the vertebral column. Dental and periodontal tissues were normal (116). 

The calcium content of human milk is only about 30 mg per 100 ml, but, provided that the volume produced by the mother is sufficient, the infant s need will be covered. Milk is low in iron but infants accumulate a store of iron during intrauterine life, and this is usually sufficient for the first 4-6 months of independent existence. After this time it is important to supplement the milk diet with iron-containing foods such as strained meat and vegetables. Milk is also relatively deficient in vitamins C and D. The vitamin C content of breast milk is usually adequate, but infants fed on cow s milk may need a supplementary source. Although fresh orange juice and rose hip syrup are good sources, it is undesirable to accustom children to sweet drinks at an early age since later on these can have disastrous effects on the teeth. 

Fig. 19.2a,b. Physical examination for developmental dysplasia of the hip. a Ortolani s maneuver is performed with the infant s hip and knee flexed by applying graded abduction open arrow) and gentle anterior pressing white arrow) to the femoral head. In a dislocated hip, a palpable clunk is felt when the femoral head passes over the posterior lahrum. b Barlow s maneuver is obtained with the hip adducted and partially flexed by pushing the knee posteriorly black arrow) and superiorly open arrow) like a piston. In patients with hip instability, a palpable clunk results from the exit of the femoral head over the posterior lahrum... 

Roovers EA, Boere-Boonekamp MM, Mostert AK et al (2005) The natural history of developmental dysplasia of the hip sonographic findings in infants of 1-3 months of age. J Pediatr Orthop B 14 325-330... 

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